Medical coding
Codes that hold up.
Diagnosis and procedure codes checked for consistency and specificity, with the DRG for every inpatient episode.
Cases coded
8
diagnosis and procedure reviewed
Consistent
100%
8 cases the payer can adjudicate
Needs recoding
0
unspecific or unsupported
Inpatient episodes grouped
4
assigned a DRG
Coding review
Select a case to see its codes and the evidence behind them.
| Case | Patient | Procedure | Diagnosis | Verdict | DRG | Amount |
|---|---|---|---|---|---|---|
| PA-2026-0093 | Aisha Al-Ghamdi | Coronary artery bypass graftInpatient | I25.10, N18.3, E11.2 | Consistent | F05AWeight 5.80 · 9 days | SAR 95,000 |
| PA-2026-0090 | Khalid Al-Otaibi | Total knee replacementInpatient | M17.11 | Consistent | I04BWeight 2.10 · 4 days | SAR 42,000 |
| PA-2026-0092 | John Okafor | Laparoscopic cholecystectomyInpatient | K80.20 | Consistent | H08BWeight 1.10 · 2 days | SAR 21,400 |
| PA-2026-0091 | Noura Al-Harbi | Caesarean section, plannedInpatient | O34.211 | Consistent | O01BWeight 0.95 · 3 days | SAR 16,500 |
| PA-2026-0083 | Fatimah Al-Zahrani | Upper GI endoscopy, diagnostic | K21.0 | Consistent | — | SAR 2,400 |
| PA-2026-0081 | Ahmed Al-Rashidi | MRI knee, unilateral | M23.20 | Consistent | — | SAR 1,800 |
| PA-2026-0082 | Maria Santos | Physiotherapy, 12-session course | M54.50 | Consistent | — | SAR 1,800 |
| PA-2026-0087 | Ravi Kumar | MRI knee, unilateral | M17.11 | Consistent | — | SAR 1,800 |
Coding detail
Coronary artery bypass graft
Consistent
PA-2026-0093·Aisha Al-Ghamdi
Codes and their evidence
- CABGCoronary artery bypass graft
- I25.10Atherosclerotic heart disease of native coronary arterytriple vessel disease
- N18.3Chronic kidney disease, stage 3Chronic kidney disease stage 3
- E11.2Type 2 diabetes mellitus with kidney complicationsType 2 diabetes
Verdict
Consistent
Every diagnosis on the case supports the procedure, and the codes are specific enough for the payer to adjudicate.
DRG assignment
DRG
F05A
Description
Coronary bypass with catastrophic CC
Relative weight
5.80
Expected length of stay
9 days
Complication drivers
N18.3, E11.2